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Idiopathic intracranial hypertension with VI CN palsy - pediatric

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Bilateral papilledema grade II with right VI nerve palsy.

Patient Data

Age: 11 years
Gender: Female

The MRI sequences demonstrate:

  • vertical tortuosity of the optic nerves
  • enlargement of the subarachnoid space around the optic nerves
  • flattening of the posterior sclera bilaterally
  • mild protrusion of the optic nerve heads 
  • the cerebral venous sinuses are patent on postcontrast sequences with no significant stenosis on the MRV
  • no mass lesion is seen at the infra- or supratentorial level.

Case Discussion

MRI features are most consistent with idiopathic intracranial hypertension.

 Idiopathic intracranial hypertension is rare in the pediatric population. A sixth cranial nerve palsy is sometimes found on neurological examination.

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